Antonio Pignatiello1, Elaine Stasiulis2, Carmela Solimine3, Omar Ayad4, Katherine M Boydell5. 1. Associate Psychiatrist-in-Chief; Medical Director, TeleLink Mental Health Program, The Hospital for Sick Children; Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Associate Dean, Health Professions Student Affairs, MD Program, University of Toronto, Toronto, Ontario. 2. Research Fellow, Child and Youth Mental Health Research Unit, The Hospital for Sick Children, Toronto, Ontario. 3. Research Manager (at time of writing), Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario. 4. Project Manager, TeleLink Mental Health Program, The Hospital for Sick Children, Toronto, Ontario. 5. Professor of Mental Health, Black Dog Institute, University of New South Wales, New South Wales, Australia.
Abstract
BACKGROUND: This study explores the physician referral and engagement process of a pediatric telemental health program based in a large urban teaching children's hospital, and identifies the processes, strengths and challenges from the perspectives of Primary Care Physicians (PCPs) and telepsychiatrist consultants. METHODS: A mixed methods approach was used. This included an online survey completed by 43 PCPs in Ontario rural communities who had referred patients to the telemental health program. Qualitative interviews were conducted with 11 child/adolescent telepsychiatrists who provide consultations via teleconferencing. RESULTS: The majority of PCPs (61%) reported somewhat to moderate satisfaction with referral experiences. Challenges identified by physicians were related to communication and administration issues including: lack of timely follow-up appointments and continuity of care; lengthy referral forms; and recommendations for mental health services not accessible in their communities. Similarly, psychiatrist consultants expressed frustration with the sparse information they received from referring physicians and most significantly, the absence of appropriate service providers/professionals during the consultation to provide collateral information and ensure uptake of recommendations. CONCLUSION: Telemental health programs provide a valuable service to PCPs and their child and youth clients that could be significantly enhanced with a different consultation model. Such models of service delivery require protocols to educate PCPs, improve communication and information sharing and establish clear expectations between PCPs and telepsychiatry consultants.
BACKGROUND: This study explores the physician referral and engagement process of a pediatric telemental health program based in a large urban teaching children's hospital, and identifies the processes, strengths and challenges from the perspectives of Primary Care Physicians (PCPs) and telepsychiatrist consultants. METHODS: A mixed methods approach was used. This included an online survey completed by 43 PCPs in Ontario rural communities who had referred patients to the telemental health program. Qualitative interviews were conducted with 11 child/adolescent telepsychiatrists who provide consultations via teleconferencing. RESULTS: The majority of PCPs (61%) reported somewhat to moderate satisfaction with referral experiences. Challenges identified by physicians were related to communication and administration issues including: lack of timely follow-up appointments and continuity of care; lengthy referral forms; and recommendations for mental health services not accessible in their communities. Similarly, psychiatrist consultants expressed frustration with the sparse information they received from referring physicians and most significantly, the absence of appropriate service providers/professionals during the consultation to provide collateral information and ensure uptake of recommendations. CONCLUSION: Telemental health programs provide a valuable service to PCPs and their child and youth clients that could be significantly enhanced with a different consultation model. Such models of service delivery require protocols to educate PCPs, improve communication and information sharing and establish clear expectations between PCPs and telepsychiatry consultants.
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